Copy of MVMS Bully Survey #1 2017-18

Question Title

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1.Have you been bullied at Mesa View this year?

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2.Please check the location(s) where you have been bullied at Mesa View. (Check all that apply)

Classroom

Restroom

C-Hallway

F-Hallway

6th grade area

PE area

Locker Room

Lunch table area

Lunch line

Parking lot

On the way to school

On the way home

On the field at lunch

Other (please specify)

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3.Have any of your friends been bullied at Mesa View this year?

Yes- go to next question

No-go to question # 7

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4.Please check the location(s) where your friend(s) have been bullied at Mesa View. (Check all that apply

Classroom

Restroom

C-Hallway

F-Hallway

6th grade area

Lunch line

Lunch table area

PE area

Locker room

Parking lot

On the way to school

On the way home

On the field at lunch time

Other (please specify)

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5.This survey is confidential. If you have been bullied, please provide the name of the student(s) who have bullied you. This is specific to you. Do not add names of students if they did not bully you personally.

Student name

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6.If you or your friends have been bullied, what are some specific things bullies have done to you?